Abstract
BackgroundAcute Kidney Injury (AKI) has evoked much interest over the past decade and is reported to be associated with high inpatient mortality. Preventable death and increased readmission rates related to AKI have been the focus of considerable interest.MethodsWe studied hospital acquired AKI in all emergency hospital admissions, except transfers from ICU to ICU or patients known to renal services, to ascertain mortality and readmission rates, and trackable modifiable factors for death, using cox regression and Kaplan Meier survival curves. Data was extracted from the electronic patient records and a series of case notes reviewed. Admissions were included between April 2006 and March 2010 (and patients followed up until September 2011).ResultsOverall incidence of AKI was 2.2%, (AKI stage 1, 61%, stage 2,27% and stage 3, 12%). In patients who sustain in-hospital AKI, 34% die in hospital, 42% are dead at 90 days and 48% at 1 year post discharge, compared to 12% 1 year mortality in patients without AKI. In multivariable analyses, AKI is an independent risk factor for in-hospital mortality (Hazard Ratio 1.6: 95% confidence intervals 1.43–1.75: P < 0.001), death within 90 days of discharge (Hazard Ratio 1.5: 95% confidence intervals 1.3–1.9: P < 0.001) and subsequent mortality beyond 90 days (Hazard Ratio 2.9: 95% confidence intervals 2.7–3.1: P < 0.001) after adjustment for co-morbidities and peak C-reactive protein.Thirty percent of the patients who died in the first 90 days post discharge and had AKI, also had malignancy. Readmission rates at 30 and 90 days were not increased by AKI after adjustment for co-morbidities and peak C-reactive protein.ConclusionsA significant proportion of deaths in the first 90 days post-discharge may not be avoidable, due to malignancy and other end-stage disease. Readmission rates were not higher in patients who had had AKI.
Highlights
Acute Kidney Injury (AKI) has evoked much interest over the past decade and is reported to be associated with high inpatient mortality
In order to establish whether there were any common factors amenable to manipulation to reduce the mortality in the patients dying in the first 90 days post discharge, we reviewed the case notes of 153 cases of patients with AKI, manually
We looked at patients who had malignancy, and what percentage of these patients died in the index admission and in the subsequent 90 days
Summary
Acute Kidney Injury (AKI) has evoked much interest over the past decade and is reported to be associated with high inpatient mortality. Acute Kidney Injury (AKI) is a frequent complication of acute illnesses requiring hospitalisation, affecting approximately 10% of patients [1] depending on how it is measured. It is associated with increased morbidity, a doubling of length of stay (LoS) in hospital [2, 3] and an excess in-hospital mortality 6–9 times greater than patients without AKI, independent of established co-morbidities [4, 5]. The data on readmission rates after an episode of AKI is even more limited with studies largely in specific diseases, showing increased readmission rates
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